尹兆会 孙晓晨

[摘要]目的：探讨鼓式取皮法切取大张次全厚皮片修复皮肤软组织缺损及薄断层皮片修复供区的效果。方法：2019年12月-2020年12月，采用鼓式取皮法切取大张次全厚皮片修复瘢痕及皮肤肿瘤切除后皮肤软组织缺损，同时在供区相邻部位切取薄断层皮片修复次全厚皮供皮区。次全厚皮片修复面积为70～200 cm2。结果：鼓式取皮法切取大张次全厚皮片、薄断层皮片快速、简便。本组10例患者除1例有小面积皮片下血肿（经换药后愈合），其余均成活理想。术后1～12个月随访，次全厚移植皮片平整，无明显挛缩畸形，皮片弹性良好，质地柔软，色素沉着较轻;次全厚皮片供区及薄断层皮片供区无明显瘢痕增生。结论：鼓式取皮法切取大张次全厚皮片，且供皮区以薄断层皮片修复方法快速、简便;而且受区移植皮片成活质量好，远期效果佳，供皮区愈合良好，无明显瘢痕增生，是皮片移植术兼顾受区及供区的一种好方法。

[关键词]次全厚皮片;鼓式取皮法;皮肤软组织缺损;创面修复;供区修复;鲜红斑痣;瘢痕

[中图分类号]R622    [文献标志码]A    [文章编号]1008-6455（2022）06-0052-03

Effects of Repairing Skin and Soft Tissue Defects with Large Sub-full-thickness Skin Grafts Cut by Drum Peeling Method

YIN Zhaohui1，SUN Xiaochen2

（1.Department of Emergency; 2.Department of Burn and Plastic Surgery，the 940th Hospital of the Joint Logistics Support Force of Chinese People’s Liberation Army，Lanzhou 730000，Gansu，China）

Abstract： Objective  To explore the effects of repairing skin and soft tissue defects with large sub-full-thickness skin grafts cut by drum peeling method and repairing the donor sites with thin fault skin grafts. Methods  From December 2019 to December 2020， the skin and soft tissue defects after scar and skin tumor resection were repaired with large sub-full-thickness skin grafts cut by drum peeling method. The donor site was repaired with thin fault skin from adjacent sites. The repair areas of sub-full-thickness skin were 70-200 cm2. Results  The drum peeling method was fast and simple in cutting large sub-full-thickness skin and thin fault skin. One case had a small area of subcutaneous hematoma （healed after dressing change）， and the skin grafts of other patients survived well. After 1-12 months follow-up， the sub-full-thickness skin graft was smooth without obvious contracture deformity， with good elasticity， soft texture and light pigmentation. There was no obvious scar hyperplasia in the two donor sites. Conclusion  This method was fast and simple. Moreover， the skin grafts in the recipient area had good survival quality and long-term effects. The donor area healed well without obvious scar hyperplasia. It is a good method for skin grafting to take care of both the recipient area and the donor area.

Key words： sub-full-thickness skin; drum peeling method; skin and soft tissue defect; wound repair; donor site restoration; nevus flammeus; scar

皮片與皮瓣移植是创面修复中最常用的方法。临床上创面大小不一，损伤程度不同，两种修复方式各有优劣[1]。对于较大范围的单纯皮肤缺损创面，应遵循整形外科“缺什么补什么”的修复理念[2]，应用皮片移植技术予以修复。而在皮片移植技术中，大张次全厚皮片的修复效果较中厚及刃厚皮片效果优良[3]。笔者科室2019年12月-2020年12月采用鼓式取皮法切取大张次全厚皮片修复缺损区域、切取薄断层皮片修复次全厚皮供皮区，受区供区均获得了满意的修复效果，现报道如下。……